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General NPI Number Information
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NPI Number | 1215448600
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE LIFECARE ACUPUNCTURE, INC.
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Dates
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Enumeration Date | 10/12/2017
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Last Update Date | 10/12/2017
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Provider Practice Location Address
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Address Line | 12304 SANTA MONICA BLVD STE 370
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City | LOS ANGELES
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State | CA
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Zip | 90025-1542
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Country | US
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Telephone | 323-609-3035
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Fax | 323-609-3035
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Provider Business Mailing Address
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Address Line | 6200 PRIMROSE AVE UNIT A
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City | LOS ANGELES
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State | CA
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Zip | 90068-3312
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Country | US
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Telephone | 310-779-2749
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | KARLY FAROVITCH
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Credential | L.AC.
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Telephone | 323-609-3035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 17756
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License Number State | CA
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